Neutrophils. Blood norm in children by age. Table segmented, stab, raised, lowered. What does this mean, the reasons that make

Normal contents of neutrophils in the blood smear is an important indicator of the health of adults and children depend on age.

Types of neutrophils and their functions

In human blood, in addition to the colored hemoglobin of red blood cells (red blood cells) circulating several types of "white" cells - white blood cells. "White blood" is responsible for the body's defense reactions and the formation of inflammation. The quantitative ratio of different types of leukocytes in the blood is called leukocyte and is the subject of the planned and urgent diagnostics.

Among leukocytes in blood are the most numerous neutrophilic granulocytes (neutrophils, NEUT) - small cells with granular contents (pellets), responsive to the lab color in both acidic and basic (alkaline) dyes. The ability to perceive both types of pigment, these cells and got its name.

Man is constantly in contact with a large number of invisible eye of microorganisms (bacteria, viruses, fungi, protozoa), densely populating not only all the surrounding space - the air, the surface of objects, food - but also the body itself.

For example, this:

• external covers;
• mouth;
• upper respiratory tract;
• gastrointestinal tract;
• end ducts genitals.

Once in the body or permanently present in it, the microflora is trying to use its space and resources for living, feeding and reproduction, which can lead to intoxication, weakening and death Host. To avoid this, in the blood and tissues of higher beings constantly operates a complex protection system - the immune system - presented by leukocytes and antibodies.

For every second, ongoing monitoring of all systems and organs and destruction of foreign agents, as the primary action to eliminate penetrated infection and induction of inflammation was responsible neutrophils. Thanks to the work of this "first response system" is not specific immunity a person can survive without showing any signs of invasion of microorganisms and do not even notice this struggle.

With a decrease of neutrophils in the blood pool of the following changes occur:

• organism often undergoes acute inflammations and infections, colds, fungal lesions;
  
• acute infections are usually protracted and hroniziruyutsya;
• Doctors often begin to diagnose chronic inflammation, sinusitis, stomatitis, pneumonia, abrasions, intestinal ulcers.

In severe forms of neutrophil immunodeficiency man can only live in an isolated sterile chamber.

neutrophil function:

1. Mikrofagotsitoz - acquisition of medium-sized external agents. The neutrophils are able to recognize pathogen advance thereto by the bloodstream and in tissues capture and destroy (or destabilize). 1 neutrophilic cell is able to absorb up to 30 units of bacterial.
2. chemotaxis. By absorbing and destroying the pathogen, neutrophils die, releasing into the environment factors that attract new neutrophils stimulate neutrophil formation process bone marrow and the blood outlet immature neutrophils from the bone marrow reserve, which is reflected in increased number of leukocyte formula young forms of neutrophils ( "shift left ").
3. induction of inflammation. Allocated dead neutrophil bactericidal enzymes cause the death of infected cells and tissues and education inflammatory factors (cytokines) that runs the secondary defenses and attracts neutrophils to the site of the new inflammation. Fatalities neutrophils and cells infected tissue, as well as killed pathogenic particles form pus, greenish the color of which is explained by the presence of neutrophils in the colored heme myeloperoxidase - a powerful bactericide.
4. Formation of extracellular DNA traps (netoz). Blood Neutrophils are programmed periodically die, throwing into the extracellular space of the "network" of strands of its nuclear DNA, equipped with detection and destruction factors penetrated into this area pathogens. If you create a trap is not nuclear and mitochondrial DNA, neutrophil remains viable. Sometimes these DNA traps become the source of pathological activity of the immune system, causing autoimmune condition (rheumatoid arthritis, lupus, thrombosis, and others).
   
5. activation antigens. Thus, neutrophils play a major role in the primary nonspecific (Reacts to any, including previously unknown alien stimuli) immunity in acute infections. Neutrophils are active mainly against bacteria and fungi, to viruses weakly active, and almost do not participate in the defense against animal parasites. Antitumor, and specific allergenic reactions, as well as the fight against chronic infections in neutrophils insignificant.

Depending on the degree of maturity (and the ability to perform protective functions) identified a number of species (developmental stages) neutrophils.

Immature bone marrow neutrophils:

1. myeloblasts - rudimentary (stem) future granulocyte cells originating in the bone marrow of common to the entire circulatory system stem cells. Normally, these cells must be present only in the bone marrow - mainly human blood-forming organs. The appearance of blasts in the blood indicates leukemia - malignant process in the blood (up to 2% in chronic and up to 5% at Stroke).
2. promyelocytes - myeloblasts maturation stage of the nucleus, the cytoplasm of which is still in its infancy, but already contains the granules with basic bactericidal enzymes.
3. neutrophil myelocytes - neutrophil progenitors, differentiated from the other two forms of granulocytes (eosinophils and basophils). Period dividing and forming precursors to metamyelocytes stage lasts approximately 4 days.
4. Neutrophil metamyelocytes (young) - terminally differentiated and mature neutrophils. Curing time is usually about 5 days.

Promyelocytes, myelocytes and metamyelocytes distinguished by a large core of unformed and immature cytoplasm, which contains few granules with working with enzymes and complexes and is capable of performing protection functions. These young cells can exit the blood in an amount of not more than 1% of the total fraction of leukocytes in the leukocyte formula.

In the case of increasing the rate to 3-5% indicate one of the following possible states:

• chronic leukemia (and other myeloproliferative tumors); as the disease progresses the number of young neutrophils reaches 10-25%;
  
• metastasized into the bone marrow of malignant renal tumors, breast or prostate cancer;
• sepsis;
• severe bacterial, fungal or viral infection in the later stages or exacerbation of chronic infection; asymptomatic infectious processes in children;
• pregnancy;
• severe intoxication any nature (infectious, alcoholic, salts of heavy metals and other species);
• irradiation (including by radiation therapy);
• chemotherapy;
• extensive blood loss;
• poisoning or overdose intolerance with prolonged use of certain drugs (anelgetiki; immunomodulators, etc.);
• excessive physical exertion or emotional;
• coma, shock;
• shifts the acid-alkaline environment.

Adult peripheral blood neutrophils:

1. band neutrophils (On the physician's jargon - "sticks") - ripening calf formed with a core in the form of curved cylinder (sticks) exiting the bone marrow into the blood pool. These cells are already in the cytoplasm of the underlying stock of reactive species, but actively fight infection, carry out phagocytosis and infiltration into tissues can not yet. At the beginning of the infection the number of "sticks" dramatically increased in the blood, while the depletion of bone marrow stem cell pool - reduced.
2. segmented neutrophils ( "Segments") - complete, fully formed and mature neutrophilic granulocytes to the nucleus, drag into segments that can perform all of its functions. After several hours of free circulation in the bloodstream of a mature neutrophil attached to the inner wall of the vessel near the wall forming a pool - group relative to the fixed cells, which, if necessary, can quickly detach from the endothelium and migrate into the focus of inflammation or injury.

Internal blood neutrophils move from the bloodstream into the pool wall surface and back are designated "redistribution" and cause the so-called leukocyte redistribution shifts that are physiological norm embodiment, but may be the cause misinterpretation blood tests.

redistribution of neutrophils occur not only when it detects an infection or inflammation, but with a sharp drop of the outside temperature medium (particularly after switching from cold to warm environment) within 2 hours after ingestion, after physical or emotional load.

With age, there is a tendency to increase the pool of the wall.

Having blood for about 6 days, mature neutrophils infiltrated in the intercellular space of the tissue, where in the absence of pathogen lives of about 2 days, and then program dies and is absorbed by another type of white blood cell - monocytes.

If the neutrophil detects and eliminates any foreign particles, its lifetime is reduced. Segmented neutrophils - basic working unit of unspecific immunity, therefore this cell type is the basis leukocyte all age person.

Neutrophils in leukocyte formula

Neutrophils (normal children by age reduced during the first year of life and increases until adulthood) most indicative of leukocyte (leukogram). Leukogram - the ratio of different types of "white" blood cells in the body, which is made by counting each cell type in the visible field of blood smear under a microscope.

Types of neutrophils in leukogram arranged according to the degree of maturity from left to right. When the number of band cells or the appearance of precursors (metamyelocytes, myelocytes, promyelocytes and blasts the more) talk about "Left shift", at lower values ​​of "rods" or the detection of a large number of segmented neutrophils to the number of segments 5 - the "shear right. "

Each of these violations indicates a deviation from the normal state of health or significant pathology.

Expressed leukocyte parameters in the following units:

1. absolute (Number of cells / particles).
2. Relative. Expressed as a percentage%.

Absolute have identical values ​​in SI units:

• (Number) / L (Example norm in adults - 4.4 billion);
• (Number) * 10⁹/ L - liter blood cells (4,4);
• cells / L - liter blood cells (4400000000);
• D / L - grams per liter of blood (4.4);
• Gchast / l - or grams per liter of particles in the blood (4,4).

As measured in conventional measurement units:

• (Number) * 10³/ L (1000 / l) - cells in the microlitre (ul) blood (4.4);
• (Number) * 10³/мм³(1000 / mm³) - cells per cubic millimeter of blood (4.4);
• k / l - microliter cell (4,4);
• A / mm³ - cells per cubic millimeter (4.4);
• cells / - cells in microliter (4400);
• cells / mm³ - cells per cubic millimeter (4400).

The norm in blood neutrophils in children by age: table

In the blood of an adult (over 13 years) is considered normal availability of all kinds of white blood cells in an amount of 4 - 10 * 10⁹/ Liter blood, including neutrophils - from 48 to 80% (1.8 - 6.5 x 10⁹/л).

For example:

1. Young neutrophils (precursors) should occur in an amount of not more than 1-3%.
2. Stab - 1 to 6%.
3. The remaining share (45-72%) occupy segmented neutrophils. Predominance of segmented neutrophils over other cells 'white' blood speaks of a "normal" state of immunity - the body's readiness to invasion potential infection, the absence of data about current or recent (within 2 weeks) infections and inflammatory states.

Neutrophils (normal children by age are presented in Table) show other relationships between the human growth. Children up to 12 years is the establishment of the immune system and the constant "training" the immune responses in infectious diseases; while there is another picture of normal leukogram.

Infants are born with a high, "adult" value segmented neutrophils in the blood, which increases until the end of the first day of life, and then drops sharply.

This phenomenon coincides with opposite lymphocyte dynamics (low-value increase-decrease) phenomenon has been called "the first overlap" (the intersection of the curves on the graph takes place on 3-5 day life). At the age of 5-15 days of segmented indicator cells is low (decreases slowly), and then begins to rapidly (within a month), and then gradually increase.

About 5-7 years, the natural physiological situation in low neutrophil link closer to the norm adults ( "second overlap", reflecting the simultaneous reduction in the number of lymphocytes, and stab cells).

At this time, pediatricians and parents report a decrease in the frequency of colds and food poisoning - the most prominent clinical manifestations of the immune system. Later on mature neutrophils figure continues to grow and reaches adult values ​​by 12-14 years.

Age neutrophils standards leukogram children:

Age	Band neutrophils,%	Segmented neutrophils,%
first day	1-5	50-70
1-5 days	1-5	35-55
5-15 days	1-4	25-45
15 days - 1 month	1-5	15-30
1 - 12 months	1-5	20-35
16 years	1-4	35-55
7-10 years	1-4	40-60
11-15	1-4	40-75

How to determine the level of neutrophils: analyzes and studies

All granular granulocytes investigated in three ways:

• by clinical blood analysis;
• in the biochemical analysis of blood;
• bone marrow biopsy.

General blood analysis

In most clinical situations scheduled and sufficient for the diagnosis of general blood analysis, which is taken from the finger. Since the "white" cells are able to respond quickly to fluctuations in the body's normal physiological state redistributive shifts and bone marrow - the change in blood formation rate, the need to comply with certain rules preparation for blood donation.

They are as follows:

1. Hunger. Before blood collection should refrain from eating and drinks for 6 hours (nursing infants - 2 hours). Food enhances the work of stem cells and the release of bone marrow pool, as well as stimulating activation of "sleeping" parietal neutrophils to a possible invasion of pathogenic agents and toxins with food.
2. Diet. In just a few days before delivery of the KLA should be excluded from the diet: fat; acute; canned food; possible - foods with nutritional supplements. All of these foods cause strain on the immune system. Drugs (especially alcohol-based) can also lead to severe changes in the standard individual leukogram.
   
3. physical rest. Intense muscle stress (physical work, sport, outdoor games) increase: the synthesis of new neutrophils in the bone marrow; causes the release into the blood of young forms of cells; lead to blood clots; cause increased blood flow, stripping mural pool in the mainstream; possible, the immune system reacts to the emergence of neutrophilic jump in the blood of harmful decay products, which is observed in the amplification of muscular work, especially in untrained people.
4. The stability of the emotional state. Acute stress, emotion, fear, joy and sadness, sudden events and news are accompanied by a surge of adrenaline and cortisol that, as in the muscular load neytrofilopoez stimulate and promote distortion of results research.
5. Equal temperature regime. Temporary fluctuations leukocyte equilibrium cause abrupt changes in ambient temperature environment, such as moving from overheated rooms on the cold or from an air conditioned - the hot the street; hot bath or shower; dressing in a cool room; perekutyvanie babies. All this can also be reflected in leukogram. To align the values ​​necessary to carry out in a homogeneous mode for about 15 minutes.
6. No damage of the skin. "Rejuvenate" leukocytic formula and may mask hidden infectious-inflammatory processes in the body: burns; cuts; wound; scratches; bruises; surgery; dental procedures; eczema and dermatitis.
7. Keeping pause after vaccination and blood transfusion. Depending on the type of vaccine length waiting period may be from 1 to 4 weeks.
8. Premenstrual period and the middle of the cycle girls can cause not only changes the values ​​of mature neutrophils, but also the appearance of young forms. For reliability of the results of the KLA is better not to donate blood one week prior to menstruation and 4-5 days after their completion, as well as, if possible, to determine the exact cycle - 2 days during ovulation.
   
9. The second half of pregnancy and childbirth cause "left shift" up to myelocytes and blasts. During childbearing enhanced hematopoietic function of bone marrow and production of all types of white blood cells in response to the appearance of the embryo and early pregnancy and childbirth - a stress state of the body, leading to changes in the activity of the immune system. However, the rate of immature forms even in this case does not exceed 3% and the proportion of reinforcement of stab - 6%. Naturally considered to increase the number of segmented cells.

Blood chemistry

Neutrophils (if the rate of children over the age has a strong deviation) require closer examination. BAC is used to refine and expand the data more general analysis of blood samples while maintaining a persistent deviations and especially - sharp "left shift".

Terms of preparation for the LHC are similar to the recommendations before handing the KLA. Blood for biochemistry analysis is taken from a vein.

Bone marrow biopsy

Biopsy is required with a steady shear leukogram considerable, especially to the left.

it is also necessary in excess of the norms of young forms more than 5%, when in history there are no indications of:

• difficult for any infectious disease;
• intoxication;
• exposure;
• long-term use of specific medicines;
• blood loss;
• prolonged coma;
• chronic stress;
• acidosis and alkalosis, caused by acute or chronic disorders of the internal organs and metabolism.

The increase of neutrophils young above 10% usually indicates the malignant hematologic pathologies (myeloproliferative disorders), and reduction below normal - about chromosomal disorders blood cell synthesis, clarify the etiology and stage which helps myelogram and cytogenetic analysis of bone biopsy brain.

Additional factors contributing to the need for such a procedure are:

• the presence of blood erythrokaryocytes - blasts of red blood cells;
• platelet fraction above 450 * 10⁹/ L (thrombocytosis);
• high content of eosinophils (more than 5%) - of another type of granule cells "white" blood;
• increase in the number of basophils (the third type of granulocyte) more than 1%;
• low value of neutrophil alkaline phosphatase;
• clinical manifestations of myeloproliferative disorders (weight loss, fatigue, bleeding and thrombosis, impaired consciousness, pain in the joints).

Biopsy administered after weighted expert analysis of data and history and KLA performed on an outpatient or inpatient setting under local anesthesia (sometimes with sedation).

Localization fence material:

• of adult material is taken from the sternum;
• Children often spend a biopsy of the pelvic bone;
• in infants is easier to carry out the manipulation on the heel, the tibial or femoral.

The procedure is relatively safe and painless, lasts about 3 minutes, requires careful preparation and reductive treatment.

Abnormalities

neutrophil norm in children can vary slightly with age. Change their normal values ​​in absolute (in numerical terms) or relative (percentage) terms indicate the general condition of their increase or reduction. More informative wbc is extended to the presence or absence of changes of the scale cell maturation.

When neutrophils increased

Leukocytosis (neutrophilia, neutrophils) was observed under the following conditions:

1. Acute infections of bacterial, fungal, protozoal or nature; infections caused by certain viruses. Most of the agents are not related to the virus, leading to a spike in blood neutrophil pool early in the disease. Subsequently the main function of controlling harmful proceeds to lymphocytes and neutrophils is reduced. If the successful outcome of the causative agent is destroyed, and the ratio of white blood cell count returns to normal.
2. Chronic and acute inflammatory conditions: rheumatoid arthritis; thyroiditis; dermatitis; peritonitis; pancreatitis; purulent inflammation.
   
3. Malignant tumors of the circulatory system, or metastasis to the bone marrow from other organs.
4. Heart attack (ischemic necrosis) infarction, kidney, lung and other organs.
5. Postoperative period, childbirth, burns or injury. The first day of recovery after surgical procedures are accompanied by natural neutrophils, when immune system emits backup blood cells in response to injury, and the parietal pool migrates to the site intervention. Saving a high rate in the future is not desirable, as evidenced by the accession of infection.
6. Endogenous (metabolic) intoxication: diabetes; for eclampsia pregnancy; necrosis of liver cells; uremia.
7. Physiological (transient and not serious) state: stress; physical and emotional stress; temperature change; pain; middle and end of the menstrual cycle; the second half of pregnancy.
8. Bites of venomous animals and other exogenous intoxication: lead; mercury; insecticides; ethylene glycol.
9. Taking certain medications: corticosteroids; acetylcholine; means on the basis of heparin; cardiac glycosides.
   
10. Acute blood loss.

Normal course of any of these disorders is the increase largely unchanged segmented shapes and light "left shift" with increased share of band neutrophils, which is observed in the successful struggle of the organism with harmless acute infections and inflammations.

Suppurative septic conditions advantageously accompanied by an increase of band cells and metamyelocytes appearance.

After depletion of white germ (bookmarks white blood stem cells in the bone marrow), which occurs when lingering infectious and septic diseases with severe, in leukogram detected even younger neutrophils step (up to blast) and disappear eosinophils.

"Rejuvenation" of formula (far left shift) may indicate a malignant process in the bone marrow. Inhibition of hematopoietic bone marrow function as endogenous intoxications, heavy and prolonged infections characterized by the appearance of degenerative (modified) of segmented forms on higher content stab cells.

Reduction in their share, followed by the "right shift" with the destruction of the nucleus of segmented neutrophils may indicate:

• kidney and liver;
• recovery after transfusion (blood transfusion);
• number of malignant anemia;
  
• Some rare mutations neutrophils healthy people who do not manifest clinically and do not affect health.

symptoms

If neutrophilia manifest clinical symptoms, it is usually the signs of the disease that caused this state leukogram.

In general, higher values ​​of neutrophil granulocytes are consistent with such phenomena:

• general weakness;
• fever;
• dizziness; blurred vision and consciousness;
• muscle pain;
• fainting;
• dystrophy.

medication

If neutrophilia caused an adequate response of the immune system to invasion of an infectious agent, the violent methods to reduce the number of neutrophils is not necessary.

Treatment in this case is:

• Corrective causes neytrotsitoza - administered antibiotic, anthelmintic, antiviral or antifungal agents;
• antihistamines;
• anti-inflammatory drugs.

Malignancies require appropriate treatment.

Usually this:

• hormone therapy;
• radiation and chemotherapy;
• bone marrow transplantation;
• transfusion.

Effects of heavy neytrotsitozov (observed, e.g., in tumors), such as cerebral circulatory, and other children's priapism, require impact directly on the amount of neutrophils blood. To reduce giperneytrotsitozov used cytostatics, anticoagulant therapy, leykotsitoferez.

Effects

In most cases, a favorable prognosis for neutrophilia: upon completion of an infectious inflammation, and sometimes at its final stage of the number of neutrophils reduced independently.

If leukocytosis caused by severely impaired hematopoietic system, the excess of granule cells is deposited on the inner walls of blood vessels and can lead to blockage of the small capillaries.

Neutrophils less than normal

Neutrophils (the norm in children over the age should not be lower than the average) can indicate very low levels. Neutropenia (neutrophil leukopenia, agranulocytosis) - a reduction of the normal number of neutrophils in leukogram, which is observed in various processes.

For example:

1. Most viral infections: influenza; chicken pox; measles; rubella; polio; hepatitis; Herpes type 6 and 7). Neutrophils are not specialized in the fight against viral agents and on arrival the body this kind of pathogens are killed very quickly.
2. Some highly virulent bacterial infections in chronic course; brucellosis; typhoid fever; paratyphoid; tuberculosis; in immunodeficiency - streptococcal and staphylococcal chronic infections, sepsis.
3. A number of diseases caused by protozoa (malaria, toxoplasmosis).
4. Fungal severe infection.
5. High body temperature (greater than 38 ° C).
   
6. Status after infection. Neutrophil depletion reserve in the bone marrow and granulocytes in the blood pool and tissue natural for this period and is not a warning sign, but indicates a weakening of the immune system and an increased risk of recurrent infection.
7. Radiation sickness, radiation therapy.
8. Aplastic anemia - congenital or acquired disorders of hematopoiesis in bone marrow.
9. Poisoning by benzene, aniline dye, and certain other substances.
10. Avitaminoses: B12 (cyanocobalamin); B9 (folic acid); B1 (thiamine); copper; gland.
11. Acute leukemia and other myelodysplastic syndromes.
12. Anaphylactic shock.
13. Rheumatic diseases.
14. Drug-induced neutropenia long-term use: some antibiotics; sulfonamides; cytostatics; nonsteroidal antiinflammatory drugs (analgesics and spasmolytics); antiepileptic drugs; agents against hyperthyroidism; medicines used to treat diabetes; anthelmintic drugs.

symptoms

The main feature, which allows the doctor to suspect neutropenia, - frequent respiratory infections (more than 8 times per year).

With the progression of a child diagnosed chronic deficit processes:

• tonsillitis;
• tonsillitis;
  
• ear infections; pustular skin lesions.

Other symptoms are:

• splenomegaly;
• swollen lymph nodes;
• general weakness.

In children with very severe deficiency of neutrophils (less than 0.5 * 10⁹/ L) during a meeting with a representative of the body of pathogenic microflora, and even its own or activate "sleeping" of the virus (eg, herpes virus, or CMV) can develop neutropenic fever (febrile neutropenia) - a dangerous condition with distinct and rapidly developing symptoms.

They are as follows:

• a sharp deterioration in health and the appearance of weakness;
• Body temperature rises above 38 ° C during an interval of half an hour to several hours;
• shivering and trembling;
• "Pouring" sweat;
• increased heart rate;
  
• a sharp drop in blood pressure, up to fainting.

medication

neutropenia treatment is to establish a feasible and eliminate the disease factor.

Therapy generally involves:

• antibiotic therapy;
• hormones;
• cytostatic agents;
• immunoglobulin (in autoimmune and febrile neutropenia).

Effects

Chronic neutropenia, mild to moderate severity is often manifested by recurrent bacterial and fungal infections.

Severe deficiency leads to a life-threatening condition in which the body can not cope even with low virulence pathogens without a powerful and dangerous corticosteroids, antibiotics, colony stimulating factors, and surgical interventions on the bone brain.

Prevention neutrophil level changes

Preventive action aimed at stabilizing blood neutrophil level, the same as general principles for strengthening the immune system and are carried out in periods of remission of chronic infectious diseases.

For example:

• intake of vitamin and mineral complexes;
• regular moderate exercise or athletic training under supervision of a qualified coach and supervised immunologist or hematologist;
  
• hardening;
• nutrition;
• avoiding crowded places during seasonal epidemics of colds;
• hygiene rules.

To protect the child from possible severe disease and detect abnormalities in the state of his health, parents should not ignore such simple and informative diagnostic methods, such as complete blood count.

After receiving leukogram child, the attending physician will evaluate the content of neutrophils, compare them with age standards, will be the clinical picture in the case of non-compliance will advance to take the necessary measures.

Author of the article: lyubov_a

Registration of the article: Lozinski Oleg

Video of normal neutrophils in children

What are neutrophils, and for which they are responsible: